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The new age semaglutide- and tirzepatide-based weight-loss jabs such as Mounjaro and Ozempic couldn’t have come any sooner to India as the country faces a twin engine public health threat of obesity and diabetes. Now, there’s more good news. A new daily pill containing the drug orforglipron developed by Eli Lilly, the makers of Mounjaro, has shown promise in the latest trials. In a trial of 3,127 adults, 20% of the people who took the once-a-day tablet for 72 weeks lost 20% or more of their body weight. Orforglipron is a glucagon-like peptide-1 (GLP-1) agonist, a type of medication that helps lower blood sugar levels, slows the digestion of food and reduces appetite. The findings of the Eli Lilly trial were published in the New England Journal of Medicine in August.
This is a significant development keeping in mind the fact that the current crop of weight loss injections are expensive costing between ₹14,000 to ₹27,500 per week – leaving them beyond the reach of a majority of the Indian population. Another problem that injectables pose is that of storage as they require refrigeration. A weight-loss pill addresses both these issues making it readily accessible to a larger proportion of the population that needs it.
CAN THESE MEDICATIONS STEM INDIA’S OBESITY PROBLEM?
India has the second highest number of adults (20-79 years) with diabetes in the world with almost 90 million adults afflicted in the country, according to the latest Diabetes Atlas report. By 2050, this number is forecast to rise to 156.7 million. With 180 million obese individuals, India has a higher incidence of the lifestyle affliction than the USA, which is third with 172 million people classified as obese, according to the Global Burden of Disease Study 2021. China tops that list with 402 million obese adults. Things are only going to get worse, as per a forecasting study published in The Lancet earlier this year, which estimated that more than half of the world’s population — 3.8 billion adults and 746 million children and young adults — will be obese or overweight by the year 2050 if urgent action isn’t taken.
Once these weight loss pills become available, a huge number of Indians will benefit both in weight management as well as diabetes control. Another bit of good news is that local pharma companies are working on cheaper alternatives to Ozempic, which are likely to hit the markets once pharma giant Novo Nordisk’s patent expires next year.
BALANCED LIFESTYLE IS KEY
Both tablet and injectable forms of these medications can help with weight loss, but they must be used under a doctor’s prescription, warns Dr Manoj Jain, consultant for general surgery (gastrointestinal, laparoscopic, bariatric, metabolic and robotic surgery) at the Kokilaben Dhirubhai Ambani Hospital in Mumbai, in light of several instances of people copying celebrities such as former tennis star Serena Williams using these drugs to achieve body image goals in quick time. “They should not be taken over the counter because they have potential side effects, including diarrhoea, loss of appetite, nausea, and, in rare cases, pancreatic or thyroid tumours,” says Jain. Gastrointestinal discomfort, bloating, stomach aches and constipation are common complaints among the users of these drugs.
These new age weight loss drugs work by mimicking the GLP-1 hormone, which helps regulate appetite and food intake, says Dr Sukhvinder Singh Saggu, director for minimal access, gastro-intestinal and bariatric surgery at the CK Birla Hospital, Delhi. “GLP-1 targets the brain’s hypothalamus, reducing hunger and enhancing the feeling of fullness. Additionally, it slows gastric emptying, meaning food stays in the stomach longer, which reduces overall calorie intake. Over time, this combination of reduced appetite and slower digestion leads to significant weight loss. By decreasing food cravings and enhancing metabolic function, semaglutide helps users lose weight more efficiently,” adds Saggu.
As studies have shown, these drugs have several benefits beyond mere weight loss. They significantly improve blood sugar control, which is particularly helpful for type 2 diabetes patients. They also reduce the risk of cardiovascular events such as heart attacks and strokes, making them beneficial for those with obesity-related heart conditions. They help lower blood pressure and improve cholesterol levels, further reducing cardiovascular risks. “In some cases, semaglutide has been found to reduce inflammation and improve liver function, particularly in people with fatty liver disease. These additional benefits make the new age drugs an attractive option for managing multiple obesity-related health issues,” says Saggu. Additionally, these drugs tend to change users’ taste buds and palate. They make unhealthy foods with high sugar, salt and fat content, and even alcohol, seem less appealing for some time.
However, despite the stupendous effectiveness of these drugs, one cannot be passive and expect the drugs to do everything as studies have shown that the effects of these drugs last only for a limited time after people stop taking them. Dr Sanjay Khare, director for bariatric medicine at Apollo Hospitals Navi Mumbai cautions, “While they are effective for weight loss, they do not replace the need for a balanced approach. Without significant lifestyle modifications, the drugs are unlikely to yield lasting results. The medicines are not a substitute for lifestyle changes but are valuable adjuncts to diet, exercise, and overall health management.”
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.
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